Report On The Condition And Well-Being Of A Ward Page 2
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53. FINAL REPORTS ONLY (Otherwise, skip to #4)
I am filing a Final Report because (check one):
I am resigning. (Complete A. below)
Ward has turned 18. (Attach Birth Certificate)
Ward has died. (Attach Death Certificate)
Other. (Please explain below)
_______________________________________________________________________________________
_______________________________________________________________________________________
A. If because of your resignation, has a successor guardian(s) been appointed? YES
NO
Successor Guardian(s) information:
Name(s) ________________________________________________________________________________
Address _____________________________________________________________________ Apt. _______
City/State/Zip ___________________________________________________________________________
Phone _______________________________________ Alternate Phone _____________________________
Email address(es) _______________________________________________________________________
Relationship to Ward ______________________________________________________________________
4. During the last year, I have visited the Ward in person _______ times. Date of last visit ________________
(If Ward lives with you, may answer 365 times and put today’s date as date of last visit, if these are correct.)
*If zero visits, explain _____________________________________________________________________
5. Ward’s residence is (check only one):
Ward’s own home
Guardian’s home
Relative’s home (give name & relationship) ________________________________________
Or, the type of facility checked below:
Group home
Hospital/Medical facility
Nursing home
Foster home
Boarding home
State Supported Living Center (State School)
Other (explain below)
Please provide NAME of facility or “other” _____________________________________________
6. How long has the Ward lived at this address? __________________________________________________
Any change in residence in the last year? ______ If yes, explain ___________________________________
_______________________________________________________________________________________
***Questions 7 & 8 only need to be completed for guardianships in County Courts at Law 1 & 2***
7. All guardians must report on the amount and source of the Ward’s income, regardless of whether the income
comes to someone other than the guardian (such as the Ward’s residence). Note that Social Security benefits
are considered income, but child support is not.
A. Source(s) of Ward’s income __________________________________________________________
B. Annual amount of Ward’s income ______________________________________ (monthly x 12)
If zero, explain ____________________________________________________________________
8. In addition to the Guardian of the Person, is there a Court-appointed Guardian of the Ward’s Estate?
(Note: Being the Rep Payee does not necessarily mean there is a Guardianship of the Estate. If you have
questions, contact your attorney, or call or email the Court Probate Auditor.)
YES (If yes, complete A. below.)
NO (If no, skip to B.)
Page 2of 5
Revised 10-8-15
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